Objectives

To begin the recruitment of:

1. Physician Opinion Leader,
2. Local Primary Care Providers including Physicians, Family Health Teams, Community Health Centres and Nurse Practitioners,
3. Local Pharmacist Champion,
4. Local Pharmacies and Pharmacists,
5. Community Health Nurse, and
6. Volunteer Peer Health Educators

Recruitment will between one to three weeks of time. This will take you into the second month of CHAP initiation into your community.

The recruitment of physicians and pharmacists to actively participate in CHAP is very important. These two professional groups are a major building block for implementing CHAP in your community. The lower the participation rate, the more challenging it is to operate CHAP, and maintain its program link to primary care.

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6.1 Physician Opinion Leader

The fact that CHAP has been highly successful in recruiting a maximum number of physicians to it is largely attributed to its use of the physician opinion leader model. These are physicians who influence their peers’ medical practice.

Identifying a physician opinion leader in your community and at the outset of the CHAP implementation process is helpful.

Other physicians value a physician opinion leader’s thoughts and preferences and as such, the opinion leader is a powerful CHAP collaborator.

• Physician Opinion Leaders are highly regarded by their peers and seen as experts in cardiovascular health. This enables them to have the ability to influence the decisions of their peers in areas pertaining to their expertise. They have a natural ability to persuade and attract the participation of others in CHAP through their expertise and enthusiasm for cardiovascular health issues.
• A CHAP physician opinion leader is the physician that other physicians call when they have a difficult case of hypertension (CVD) in their office, or when they have a question about hypertension (CVD).
• Physician Opinion Leaders are a networking resource because of their understanding of the social and communication networks of other physicians. They will be very knowledgeable as to how to best engage the majority of their peers into CHAP.
• They have a keen interest in health promotion and community development.

There are a number of ways to find the physician opinion leader in your community. Here are several suggestions to assist in identifying a physician opinion leader.

1. Networking: Talk to local physicians and other community contacts and ask about physicians who are involved in community health or have a particular interest in cardiovascular health promotion.
2. Environmental Scan: A physician opinion leader may have been determined during the environmental scan given that opinion leaders are often found in hospitals, research labs, academic posts and private practices. Review your community profile to see if there are any relevant groups or associations that could be contacted to help identify a local physician opinion leader.
3. Family Health Team/Community Health Centre: Contact the Executive Director or Administrator of local Family Health Teams/Community Health Centers. They may not only want to participate in CHAP, but may have a physician who would be a physician opinion leader or physician champion for CHAP.
4. Local Hospital Administrators or Medical Officer of Health: Phone your local Hospital Administrators and/or Medical Officer of Health and ask if they are aware of a potential local physician opinion leader on cardiovascular health issues.
5. Local Lead Organization: Discussions within your local lead organization may lead to a local physician opinion leader.
6. Pharmacists: When speaking with pharmacists regarding CHAP, take the opportunity to ask them who they view as the local physician expert or advocate for cardiovascular health issues.

Once you have identified a physician opinion leader, arrange a meeting to introduce them to CHAP and their role in establishing CHAP in the community. Ask the physician opinion leader to play a key role in the recruitment of physicians including:

• Delivering presentations at information sessions or meetings.
• Signing letters to local physicians.
• Talking with other physicians about CHAP on an informal basis.
• Helping to identify alternative ways to recruit local physicians.

There are several ways to find physicians in your community:

1. The Phone Book: Look in the yellow pages and www.411.ca
2. Internet searches
3. Memberships in medical associations. For example, the Ontario Medical Association
4. The Local Public Health Unit
5. Family Health Teams and Community Health Centres

Once you have a complete list of physicians/primary care providers, record all contact information to enable you to recruit physicians/primary care providers.

How to Recruit Physicians

There are a number of methods that can be used to recruit physicians:

1. Hold an information session hosted by the physician opinion leader.
2. Attend an existing meeting of physicians where CHAP can be an information item on the agenda.
3. Mail letters to local physicians and follow up with phone calls and office visits.

It is highly unlikely that all physicians will be recruited by using one particular method only; several methods need to be used consecutively in order to attract a high level of physician participation.

1. Information Session

A sample Power Point presentation that could be delivered during an information session can be found in Appendix 3.0. Many physicians in the community will not be able to attend the session for a variety of reasons. Take attendance at these session so that follow up phone calls and letters can be made to non-attending physicians.

The physician opinion leader can sign the invitation for physicians to attend this information session. The invitation letter should briefly introduce CHAP and outline the format for the session, using:

• Physician’s Letter of Invitation to Information Session (Appendix 4.1), and
• CHAP Fact Sheet (Appendix 2.2).

At the end of the session, hand out the Family Physician Letter of Understanding (Appendix 4.2) and the Family Physician Information Sheet (Appendix 4.3) so that physicians who wish to participate can indicate their preference for inviting patients to participate in CHAP. In addition, include the CHAP Protocol for Blood Pressure Readings (Appendix 4.4) so physicians are familiar with the procedure followed at CHAP sessions.

2. Attend an Existing Physician Meeting

Another effective way to reach physicians is to ask to be put onto the agenda of an existing physician meeting. Such meetings might take place at the hospital, within a family health team, at an academic institution, or within the local public health unit. Ask if the physician opinion leader or local CHAP coordinator, or representative from the Local Lead Organization or CHAP Central could provide an overview of CHAP. The Information Session Sample Presentation (Appendix 3.0) could be modified to best suit the meeting. Presentation handouts include:

• CHAP Fact Sheet (Appendix 2.2),
• Family Physician Information Sheet (Appendix 4.3), and
• CHAP Session Blood Pressure Recommendation Protocol (Appendix 4.4).

3. Letters, Phone Calls and Follow-up Visits

If an opportunity for an information session or meeting does not exist, or if you have yet to reach all physicians in your community, contact the office staff of each local physician. A personalized visit or phone call to introduce CHAP to the office staff, followed up by a short meeting to further discuss CHAP with the physician. Send an information package including:

• CHAP Fact Sheet (Appendix 2.2),
• Family Physician Information Sheet (Appendix 4.3), and
• CHAP Protocol for Blood Pressure Readings (Appendix 4.4).

During the follow up visits, the Family Physician Recruitment Guide (Appendix 4.5) should be used to ensure all details are covered.

If a few physicians indicate that they still do not wish to participate, follow-up with them again. The numbers of participating physicians may persuade the non-participating physicians to reconsider CHAP at that time

Recruiting Other Primary Care Providers: Family Health Teams

CHAP is an established strategy for chronic disease prevention and management that embraces partnerships between primary care providers and resources in communities. Many Family Health Teams (FHTs) are engaged in or planning similar initiatives to serve their patients and communities. CHAP offers the necessary resources, tools and systems for primary care teams to offer a sustainable program to address risk factors for cardiovascular disease and other chronic diseases. Blood pressure and other risk factors assessed at CHAP sessions are common across multiple chronic diseases. CHAP provides education and self-help tools designed to involve patients in addressing modifiable risk factors. CHAP can be tailored to the expertise of providers and the needs of patients and the local community while maintaining its standardized components.

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6.3 Local Pharmacist Champion

At the outset of your pharmacy recruitment efforts, determine whether your community has a “pharmacist champion”. Similar to the local physician opinion leader, this person is the pharmacist who is viewed by their peers as being a leader in health issues.

Discussions with local physicians, the local public health unit, the local hospital administrator, the local lead organization, and CHAP Central will identify such an individual in your community.

Once you have identified a pharmacist champion, arrange a meeting to introduce them to CHAP and their role in establishing CHAP in your community. Ask the pharmacist champion to play a key role in the recruitment of pharmacists and pharmacies including:

• Signing letters to local pharmacies.
• Meeting with other pharmacists to encourage them to participate in CHAP.
• Talking with other pharmacists about CHAP on an informal basis.
• Delivering presentations at information sessions or meetings of other pharmacists in the area.

Pharmacies are the main location of the CHAP sessions. The recruitment of pharmacies to participate in CHAP is important.

Finding Pharmacies and Pharmacists

There are several ways to find pharmacies and pharmacists in your community:

1. The Phone Book: Look in the yellow pages and www.411.ca
2. Internet Searches
3. Local or provincial pharmacy associations
4. The Local Public Health Unit
5. Family Health Teams

Once you have a complete list of local pharmacies and pharmacists, record all contact information to enable you to recruit the pharmacists/pharmacies.

How to Recruit Pharmacies and Pharmacists

It is easier and more effective to contact each pharmacist personally to discuss CHAP. The following method has been found to be effective:

• Call each pharmacy and arrange an appointment to discuss CHAP with the appropriate pharmacist or pharmacy owner.
• Following each phone call, send a copy of the following:
  • Community Pharmacist Information Sheet (Appendix 5.1),
  • CHAP Pharmacist Assessment Form (Appendix 5.2), and
  • Pharmacist Letter of Understanding (Appendix 5.3).

During the meeting with the pharmacist or pharmacy owner:

• Discuss CHAP in more detail.
• Discuss and sign the Pharmacist Letter of Understanding (Appendix 5.3).
• Review the CHAP Pharmacist Assessment Form (Appendix 5.2), CHAP Session Blood Pressure Recommendation Protocol (Appendix 4.4), and the Meds Check Program.
• Determine the place within the pharmacy to hold the session, as well as the times and dates for CHAP sessions.
• Ask whether the pharmacist would be willing to staple a copy of the CHAP session schedule to patient’s prescription bags.

After the meeting with the pharmacist or pharmacy owner:

• Send a letter of confirmation to the pharmacists/pharmacy owners regarding their participation in CHAP and the schedule for CHAP sessions.
• Advise the Local Lead Organization and collaborating organizations of recruitment progress.
• Follow up with each pharmacy regarding CHAP session set-up.

Advertise in the community for a Community Health Nurse to work on an “ad hoc” basis.

The responsibilities of the Community Health Nurse include:

1. Assist in the development and delivery of volunteer peer health educator training sessions and refresher sessions.
2. Be available on-call during the CHAP sessions to respond to volunteer peer health educator questions and address urgent cases that require reassessment.
3. Interact with health care providers on urgent participant needs as required.

See Appendix 1.2 for a Community Health Nurse Job Description.

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6.6 Volunteer Peer Health Educators

Volunteer Peer Health Educators are an integral part of CHAP. Their role is invaluable and contributes to the success of CHAP in each community.

Volunteers became involved in CHAP for one of the following reasons:

1. Through a friend/word of mouth,
2. Notice posted in the newspaper,
3. Talk/contacted by local CHAP Coordinator,
4. Contacted by agency,
5. Notice board at a community venue.

This information is based on the 2006 top five CHAP recruitment methods for volunteers.

Recruiting volunteer peer health educators is an essential part of CHAP. Based on the current CHAP communities, volunteer responsibilities at CHAP sessions include:

• Greet participants and help them to sign the consent form.
• Assist participants with filling out the top portion of the Risk Profile Recording Form (Appendix 7.3), complete the risk profile, look up the pharmacist and physician, assist with measuring the participant’s blood pressure, and make recommendations based on CHAP Blood Pressure Reading Protocol.
• Help out in all areas for sessions that are anticipated to be very well attended.

The number of volunteers needed to run the CHAP sessions in your community will depend on the number of participating pharmacies in your community, and the number of participating physicians.

For the purposes of CHAP, older adults are the best group from which to draw volunteer peer health educators for the following reasons.

• Participants are comfortable with people their own age taking their blood pressure and conversing with them on health issues.
• Older adults are part of the “target group” and as such volunteer peer health educators can act as ambassadors to the program with friends and family members who might also benefit from attending a blood pressure session.

Volunteers should be able to commit to attend training sessions.

How to Recruit Volunteer Peer Health Educators

• Refer to your community profile for a list of groups to contact to recruit volunteers. These groups will include volunteer centers, senior community centers, and church groups.
• Telephone each group. Follow up with a letter by fax or mail, which provides an overview of CHAP, the role of the volunteer peer health educators, and the expected commitment of volunteers.
• Include an advertisement in the local newspaper with the Sample Volunteer Recruitment Poster (Appendix 2.6).
• Distribute posters about CHAP in the various locations where older adults gather and include a tear-off telephone number and name for more information about CHAP.
• Ask to be put on the agenda of speaking engagements to older adults where you can speak about CHAP and its opportunity for volunteers using the Volunteer Recruitment Presentation (Appendix 6.1).

As you recruit volunteers, record all contact information, including how they heard about CHAP. Once your list of peer health educators is confirmed, start to coordinate training sessions.

Volunteer Peer Health Educator Training Sessions

Training sessions must be held for volunteer peer health educators. More detailed information on training sessions is found in Planning for CHAP Sessions.

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